segunda-feira, 31 de março de 2008
Vaccines for women to prevent neonatal tetanus
Demicheli V, Barale A, Rivetti A
This review should be cited as: Demicheli V, Barale A, Rivetti A. Vaccines for women to prevent neonatal tetanus (Cochrane Review). In: The Cochrane Library, Issue 4, 2007. Oxford: Update Software.
A substantive amendment to this systematic review was last made on 15 August 2005. Cochrane reviews are regularly checked and updated if necessary.
Abstract
Background
Tetanus is an acute, often fatal, disease caused by an exotoxin produced by Clostridium tetani. It occurs in newborn infants born to mothers who do not have sufficient circulating antibodies to protect the infant passively, by transplacental transfer. Prevention may be possible by the vaccination of pregnant or non-pregnant women, or both, with tetanus toxoid, and the provision of clean delivery services. Tetanus toxoid consists of a formaldehyde-treated toxin which stimulates the production of antitoxin.
Objective
To assess the effectiveness of tetanus toxoid, administered to women of childbearing age or pregnant women, to prevent cases of, and deaths from, neonatal tetanus.
Search strategy
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (July 2007), The Cochrane Library (2007, Issue 2), MEDLINE (1966 to June 2007), EMBASE (1974 to June 2007). We also used the results from handsearching and consultations with manufacturers and authors.
Selection criteria
Randomised or quasi-randomised trials evaluating the effects of tetanus toxoid in pregnant women or women of childbearing age on numbers of neonatal tetanus cases and deaths.
Data collection and analysis
Three review authors independently assessed trials for inclusion and trial quality, and extracted data.
Main results
Two trials (10,560 infants) were included. One study (1919 infants) assessed the effectiveness of tetanus toxoid in preventing neonatal tetanus deaths. After a single dose, the relative risk (RR) was 0.57 (95% confidence interval (CI) 0.26 to 1.24), and the vaccine effectiveness was 43%. With a two or three dose course, the RR was 0.02 (95% CI 0.00 to 0.30); vaccine effectiveness was 98%. No effect was detected on causes of death other than tetanus. The RR of cases of neonatal tetanus after at least one dose of tetanus toxoid was 0.20 (95% CI 0.10 to 0.40); vaccine effectiveness was 80%. Another study, involving 8641 children, assessed the effectiveness of tetanus-diptheria toxoid in preventing neonatal mortality after one or two doses. The RR was 0.68 (95% CI 0.56 to 0.82); vaccine effectiveness was 32%. In preventing deaths at 4 to 14 days, the RR was 0.38 (95% CI 0.27 to 0.55), and vaccine effectiveness 62% (95% CI 45% to 73%).
Reviewers' conclusions
Available evidence supports the implementation of immunisation practices on women of childbearing age or pregnant women in communities with similar, or higher, levels of risk of neonatal tetanus, to the two study sites. More information is needed on possible interference of vaccination by malaria chemoprophylaxis on the roles of malnutrition and vitamin A deficiency, and on the quality of tetanus toxoid production and storage.
Demicheli V, Barale A, Rivetti A
This review should be cited as: Demicheli V, Barale A, Rivetti A. Vaccines for women to prevent neonatal tetanus (Cochrane Review). In: The Cochrane Library, Issue 4, 2007. Oxford: Update Software.
A substantive amendment to this systematic review was last made on 15 August 2005. Cochrane reviews are regularly checked and updated if necessary.
Abstract
Background
Tetanus is an acute, often fatal, disease caused by an exotoxin produced by Clostridium tetani. It occurs in newborn infants born to mothers who do not have sufficient circulating antibodies to protect the infant passively, by transplacental transfer. Prevention may be possible by the vaccination of pregnant or non-pregnant women, or both, with tetanus toxoid, and the provision of clean delivery services. Tetanus toxoid consists of a formaldehyde-treated toxin which stimulates the production of antitoxin.
Objective
To assess the effectiveness of tetanus toxoid, administered to women of childbearing age or pregnant women, to prevent cases of, and deaths from, neonatal tetanus.
Search strategy
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (July 2007), The Cochrane Library (2007, Issue 2), MEDLINE (1966 to June 2007), EMBASE (1974 to June 2007). We also used the results from handsearching and consultations with manufacturers and authors.
Selection criteria
Randomised or quasi-randomised trials evaluating the effects of tetanus toxoid in pregnant women or women of childbearing age on numbers of neonatal tetanus cases and deaths.
Data collection and analysis
Three review authors independently assessed trials for inclusion and trial quality, and extracted data.
Main results
Two trials (10,560 infants) were included. One study (1919 infants) assessed the effectiveness of tetanus toxoid in preventing neonatal tetanus deaths. After a single dose, the relative risk (RR) was 0.57 (95% confidence interval (CI) 0.26 to 1.24), and the vaccine effectiveness was 43%. With a two or three dose course, the RR was 0.02 (95% CI 0.00 to 0.30); vaccine effectiveness was 98%. No effect was detected on causes of death other than tetanus. The RR of cases of neonatal tetanus after at least one dose of tetanus toxoid was 0.20 (95% CI 0.10 to 0.40); vaccine effectiveness was 80%. Another study, involving 8641 children, assessed the effectiveness of tetanus-diptheria toxoid in preventing neonatal mortality after one or two doses. The RR was 0.68 (95% CI 0.56 to 0.82); vaccine effectiveness was 32%. In preventing deaths at 4 to 14 days, the RR was 0.38 (95% CI 0.27 to 0.55), and vaccine effectiveness 62% (95% CI 45% to 73%).
Reviewers' conclusions
Available evidence supports the implementation of immunisation practices on women of childbearing age or pregnant women in communities with similar, or higher, levels of risk of neonatal tetanus, to the two study sites. More information is needed on possible interference of vaccination by malaria chemoprophylaxis on the roles of malnutrition and vitamin A deficiency, and on the quality of tetanus toxoid production and storage.
segunda-feira, 24 de março de 2008
Maternal and neonatal tetanus.
Roper MH, Vandelaer JH, Gasse FL.
Weybridge, VT, USA.
Maternal and neonatal tetanus are important causes of maternal and neonatal mortality, claiming about 180 000 lives worldwide every year, almost exclusively in developing countries. Although easily prevented by maternal immunisation with tetanus toxoid vaccine, and aseptic obstetric and postnatal umbilical-cord care practices, maternal and neonatal tetanus persist as public-health problems in 48 countries, mainly in Asia and Africa. Survival of tetanus patients has improved substantially for those treated in hospitals with modern intensive-care facilities; however, such facilities are often unavailable where the tetanus burden is highest. The Maternal and Neonatal Tetanus Elimination Initiative assists countries in which maternal and neonatal tetanus has not been eliminated to provide immunisation with tetanus toxoid to women of childbearing age. The ultimate goal of this initiative is the worldwide elimination of maternal and neonatal tetanus. Since tetanus spores cannot be removed from the environment, sustaining elimination will require improvements to presently inadequate immunisation and health-service infrastructures, and universal access to those services. The renewed worldwide commitment to the reduction of maternal and child mortality, if translated into effective action, could help to provide the systemic changes needed for long-term elimination of maternal and neonatal tetanus.
PMID: 17854885 [PubMed - indexed for MEDLINE]
Roper MH, Vandelaer JH, Gasse FL.
Weybridge, VT, USA.
Maternal and neonatal tetanus are important causes of maternal and neonatal mortality, claiming about 180 000 lives worldwide every year, almost exclusively in developing countries. Although easily prevented by maternal immunisation with tetanus toxoid vaccine, and aseptic obstetric and postnatal umbilical-cord care practices, maternal and neonatal tetanus persist as public-health problems in 48 countries, mainly in Asia and Africa. Survival of tetanus patients has improved substantially for those treated in hospitals with modern intensive-care facilities; however, such facilities are often unavailable where the tetanus burden is highest. The Maternal and Neonatal Tetanus Elimination Initiative assists countries in which maternal and neonatal tetanus has not been eliminated to provide immunisation with tetanus toxoid to women of childbearing age. The ultimate goal of this initiative is the worldwide elimination of maternal and neonatal tetanus. Since tetanus spores cannot be removed from the environment, sustaining elimination will require improvements to presently inadequate immunisation and health-service infrastructures, and universal access to those services. The renewed worldwide commitment to the reduction of maternal and child mortality, if translated into effective action, could help to provide the systemic changes needed for long-term elimination of maternal and neonatal tetanus.
PMID: 17854885 [PubMed - indexed for MEDLINE]
segunda-feira, 17 de março de 2008
Base de dados :
LILACS
Pesquisa :
"tetania neonatal" [Descritor de assunto] and Recem-nascido [Limites]
Referências encontradas :
2 [refinar]
Mostrando:
1 .. 2 no formato [Detalhado]
LILACS
Pesquisa :
"tetania neonatal" [Descritor de assunto] and Recem-nascido [Limites]
Referências encontradas :
2 [refinar]
Mostrando:
1 .. 2 no formato [Detalhado]
segunda-feira, 10 de março de 2008
biblioteca virtual em saúde
Infant Mortality
Descritor Espanhol:
Mortalidad Infantil
Descritor Português:
Mortalidade Infantil
Sinônimos Português:
Mortalidade de Menores de 1 Ano de IdadeMortalidade Infantil por Risco EspecíficoMortalidade Infantil por Unidade TerritorialMortalidade do Lactente
Categoria:
E05.318.308.985.550.475G03.850.505.400.975.550.475G03.850.520.308.985.550.475L01.280.975.550.475N01.224.935.698.489SP3.076.187.173.164SP4.011.127.413.639.905.376SP5.006.052.168.154.110
Definição Português:
Óbitos de crianças entre 28 dias e 365 dias após o NASCIMENTO em uma população (de acordo com a definição do Centro Nacional de Estatística da Saúde). A mortalidade perinatal é definida da 28ª semana de GESTAÇÃO ao 7º dia após o nascimento.A mortalidade neonatal representa as mortes até 27 dias após o nascimento.
Nota de Indexação Português:
um conceito largamente estatístico & não um substituto para /mortal com DOENÇAS DO RECÉM-NASCIDO ou com doença específica em lactente; especifique geog; precod LACTENTE; em SP veja também específicos: MORTALIDADE NEONATAL, MORTALIDADE PERINATAL e MORTALIDADE INFANTIL TARDIA
Descritor Espanhol:
Mortalidad Infantil
Descritor Português:
Mortalidade Infantil
Sinônimos Português:
Mortalidade de Menores de 1 Ano de IdadeMortalidade Infantil por Risco EspecíficoMortalidade Infantil por Unidade TerritorialMortalidade do Lactente
Categoria:
E05.318.308.985.550.475G03.850.505.400.975.550.475G03.850.520.308.985.550.475L01.280.975.550.475N01.224.935.698.489SP3.076.187.173.164SP4.011.127.413.639.905.376SP5.006.052.168.154.110
Definição Português:
Óbitos de crianças entre 28 dias e 365 dias após o NASCIMENTO em uma população (de acordo com a definição do Centro Nacional de Estatística da Saúde). A mortalidade perinatal é definida da 28ª semana de GESTAÇÃO ao 7º dia após o nascimento.A mortalidade neonatal representa as mortes até 27 dias após o nascimento.
Nota de Indexação Português:
um conceito largamente estatístico & não um substituto para /mortal com DOENÇAS DO RECÉM-NASCIDO ou com doença específica em lactente; especifique geog; precod LACTENTE; em SP veja também específicos: MORTALIDADE NEONATAL, MORTALIDADE PERINATAL e MORTALIDADE INFANTIL TARDIA
descritores
Descritor Inglês:
Tetanus
Descritor Espanhol:
Tétanos
Descritor Português:
Tétano
Categoria:
C01.252.410.222.864
Definição Português:
Uma doença causada pela tetanospasmina, uma toxina proteica potente produzida pelo CLOSTRIDIUM TETANI. O tétano ocorre freqüentemente após um ferimento agudo, tal como uma ferida por perfuração ou por laceração. O tétano generalizado, a forma mais comum, é caracterizado por contrações musculares tetânicas e hiperreflexia. O tétano localizado apresenta-se como uma condição atenuada com manisfestações restritas dos músculos próximos ao ferimento. Ele pode progredir para a forma generalizada.
Tetanus
Descritor Espanhol:
Tétanos
Descritor Português:
Tétano
Categoria:
C01.252.410.222.864
Definição Português:
Uma doença causada pela tetanospasmina, uma toxina proteica potente produzida pelo CLOSTRIDIUM TETANI. O tétano ocorre freqüentemente após um ferimento agudo, tal como uma ferida por perfuração ou por laceração. O tétano generalizado, a forma mais comum, é caracterizado por contrações musculares tetânicas e hiperreflexia. O tétano localizado apresenta-se como uma condição atenuada com manisfestações restritas dos músculos próximos ao ferimento. Ele pode progredir para a forma generalizada.
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